EMERGENCY MCDONALD CERCLAGE WITH APPLICATION OF STAY SUTURES

Objective: To evaluate the efficiency of emergency cervical cerclage, and the use of stay sutures. Study design: Retrospective review of pat ients who were treated with emergency cervical cerclage at our departm ent between January 1984 and April 1994. McDonald cerclage, after trac tion of the cervix with 6-10 stay sutures, was inserted in 16 women be tween 16 and 28 weeks gestation, presenting with dilated cervix and pr otruding membranes. Tocolytics and prophylactic antibiotics were given to most patients. Results: All cerclage operations were primarily per formed without complications, except in one case where membranes ruptu red during operation. Two reoperations were necessary, and were succes sfully performed. The median duration of pregnancy after the procedure was 4.5 weeks (range 1 day-18 weeks), and the median birth weight was 1250 g (range 130-4330 g). In 10 of 16 patients (63%), the duration o f pregnancy prolongation was between 2.5 and 18 weeks (median 7.0 week s) following cerclage, with a median birth weight of 2145 g (range 995 -4330 g). Four of these patients (25%) delivered at term. In the other six patients, pregnancy lasted seven days or less, resulting in four abortions, and two surviving infants. Eleven of the 16 pregnancies (69 %) resulted in live infants. Conclusion: Pregnancy can be significantl y prolonged following emergency cervical cerclage, and the procedure m ay contribute to improved neonatal outcome.